A new program aimed at treating Ontario first responders disabled by work-related post-traumatic stress injuries (PTSI) has shown promising results—but not for return-to-work rates.
Commissioned by the Workplace Safety and Insurance Board (WSIB) and created and delivered by Trillium Health / Insight Health Solutions, the First Responder Mental Health Treatment Program (FRMHT) was designed exclusively for public safety workers such as police officers, firefighters, paramedics and corrections officers. The program has three distinct features: it was an intensive 14-week outpatient program, first responders participated in treatment in small groups, and the large majority of therapy sessions were delivered virtually.
In its pilot phase, the treatment program has gone through a multi-part evaluation by the Institute for Work & Health (IWH) and the Institute for Better Health to inform improvements or changes to the program.
“In a given year, 800 to 900 public safety workers file a compensation claim for PTSI arising from their work,” says Cameron Mustard, IWH adjunct scientist and lead on a new study that formed part the evaluation. “PTSI is a complex mental health injury, and can take years to recover from,” says Mustard.
The study found that there was no difference in return-to-work rates among those who participated in the program compared to those who were referred to the program but did not start treatment. The study is published in the Journal of Occupational Rehabilitation (doi:10.1007/s10926-025-10337-9).
“While we didn’t see improvements in return-to-work rates, if you factor in all of the results, from each stage of this evaluation, the program was very well received overall by the participants and the staff delivering treatment,” says Kathleen Dobson, IWH associate scientist and part of the study team.
How did the program affect return-to-work outcomes?
The goals of the program are to reduce impairment, improve health and function and to support workers who are considering returning to work. The program does this by offering a stepped model of care that includes triage, assessment, residential care where appropriate, outpatient rehabilitation, aftercare and residential psychoeducational group activities with other first responders.
One of the expected outcomes of the program was that workers who participated in treatment would return to work sooner than workers that did not receive treatment. To measure this, the IWH study team followed a group of 472 public safety personnel with PTSI arising in 2018 or later who were referred to the program between November 2021 to June 2023. Of this group, 54 per cent went on to participate in treatment.
During the 18 to 36 months following a referral to the program, the rate of treatment participants returning to work—about 30 per cent—was no different from that of workers who were referred but did not receive treatment.
Additionally, return to work outcomes were more positive—about 40 per cent—among a matched comparison group of public safety personnel disabled by PTSI who were not referred for treatment. The non-referred comparison group was similar in terms of age, sex, occupation, date of injury and duration of work disability.
Dobson notes that the limited influence of treatment on return-to-work outcomes may be due in part to the fact that most workers referred to the program had been off work with PTSI for long periods—only 2 per cent had a claim of less than one year’s duration. In comparison, in the broader population of public safety workers in the study with an accepted lost-time claims for mental health conditions, that percentage was 42 per cent.
“Since this was a new, high-intensity program, the majority of people who were referred to it were those with workers’ compensation claims lasting two or more years,” says Dobson. “As the most severely injured, these workers would have been prioritized for the program since, even after many years, their symptoms hadn’t improved enough to return to work.”
It’s possible that the return-to-work outcomes would have been more positive if more workers with recent injuries were included, she notes.
She also notes previous IWH research demonstrating that the accommodations and supports available in a workplace can affect workers’ ability to return to work. Public safety employers are increasingly recognizing the challenges of helping workers with PTSI return to their jobs, and the need to strengthen return-to-work supports for these workers.
Symptom improvements and high retention
Today, the program continues to run, now out of its pilot phase. That’s owing to the general success of how the program was perceived and implemented, says Mustard.
“Improving return-to-work outcomes is one goal of the program, but other results we saw indicated that the program was helpful for participants in other ways,” he says.
For example, he points to unpublished findings that 25 per cent of those attending the program reported that their PTSI symptoms had improved by the end.
Another part of the evaluation, one based on interviews with 30 participants and care providers (doi:10.1371/journal.pmen.0000536), found that workers particularly appreciated how tailored the program was to their experiences. They also appreciated how intensive and structured it was. At three to four sessions per week for 14 weeks, full attendance required 60 to 70 hours. Interviewees noted that the lack of intensity in other types of therapy was a reason that workers didn’t see much improvement in their symptoms.
Despite the substantial time commitment, 80 per cent stuck with the program for 10 or more of the 14 weeks. Seventy-four per cent of participants attended 30 or more group and individual therapy sessions.
“The retention rate was very high,” says Mustard. “The fact that such a high proportion of first responders stayed in such an intensive program for most or all of the sessions shows that they found value in the sessions.”
Employers’ role in helping public safety workers return to work
To help workers with PTSI return to work sooner, the evaluation team suggested that employers consider offering partial or graduated return to work or coming up with creative solutions for what jobs people could do upon their return.
“There does seem to be an important role for employers to be innovative in expanding their commitment and capacity to bring people back to work,” says Mustard. “PTSI can be a lifelong chronic condition for workers. It’s possible they will never be 100 per cent symptom-free.”
“Employers should think about creative ways to bring workers back to work where they’re doing something valuable, even if it’s not in exactly the same role they held before their injury.”